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Cysts, Moles and Skin Tags Removal:

There are a variety of skin issues including cysts, moles and skin tags that we do not want on our skin. Some of these are amenable to treatment with either laser or intense pulsed light (IPL)   therapy. Others require surgical treatment to remove.  The depth of the lesion and it’s characteristics are the main determinants with respect to the response to treatment.

Cysts

Cysts are harmless, sac-like growtsh in the deeper layers of the skin. They form from the lining of a hair follicle that gets blocked. It is not known why cysts appear, nor why some persons get many of them.

Types of cyst include:

• Acne comedones (whiteheads)
• Acne cysts (large uninflamed acne lumps)
• Dermoid cyst (a developmental inclusion cyst)
• Milia (tiny surface white balls often found on the cheeks after sun exposure or following an injury). Milia can easily be squeezed out.
• Epidermal cysts (soft cheese-like contents)
• Trichilemmal cysts (scalp cysts, often multiple and familial, arising from hair root sheath)
• Pilar cysts (firm white content)
• Steatocystoma multiplex (multiple inherited cysts on trunk)
• Digital myxoid cyst (cyst at the base of a nail)
• Pseudocyst of auricle (cyst on the external ear)
• Labial mucous cyst (cyst in the lip)
• Apocrine hidrocystoma (clear jelly-like cyst of eyelid)
• Bartholin's cyst (vulval swelling)

Benign cysts may sometimes be confused with skin cancers, especially a nodular or 'cystic' basal cell carcinoma.

The epidermal cyst sac is filled with a soft, whitish brown material that sometimes oozes out onto the skin's surface. This material, which is keratinous debris (dead skin cells), smells like rotten cheese.

Ruptured cysts

Cysts can get inflamed if the contents of the cyst rupture into the surrounding skin. This makes them red and painful, and they may discharge yellow pus.

Occasionally bacteria enter the cyst and cause an infection that resembles a boil. When this happens, antibiotics such as flucloxacillin taken by mouth and minor surgery may be needed to relieve the pressure and pain.

Treatment

If you have a cyst, ask your dermatologist's or doctor's advice.

Small cysts (eg. less than 5 mm) don't usually need treatment, but can be readily removed by a minor surgical procedure. Larger ones are usually removed because they are unsightly or because they have been inflamed.

Cysts are treated by making a small surgical opening into the skin and removing the sac (excision biopsy). This is done under local anaesthetic and may require stitches, removed a few days later.  Very occasionally the cyst recurs and needs further treatment.

Moles

Moles are common usually harmless skin lesions. They are correctly called melanocytic naevi (American spelling ‘nevi’) as they are due to a proliferation of the pigment cells, melanocytes. Moles may be flat or protruding. They vary in colour from pink flesh tones to dark brown or black. The number of moles a person has depends on genetic factors and on sun exposure; most people have 20-50 of them.

Melanocytic naevi may be present at birth (congenital) but more usually begin to grow during childhood although new ones can appear at any age, sometimes in crops. Early naevus cells form nests on the junction between the epidermis (outer layer of the skin) and the dermis (inner layer) so are known as junctional naevi. These are flat colorful moles. With maturity, nests of naevus cells can also form in the dermis (compound naevi) or may only be found in the dermis (intradermal naevi). These naevi are thickened and often protrude from the skin surface. Non-pigmented dermal naevi may also be called cellular naevi. Heavily pigmented dermal naevi appear blue (blue naevi).

Moles may darken following sun exposure or during pregnancy. During adulthood they often lose their pigmentation, and they may even disappear in old age.

Congenital pigmented naevus

A mole present at birth is called a congenital pigmented naevus. One in a hundred babies have a congenital pigmented naevus varying in size from a few millimetres in diameter to covering half the baby's skin. There may an increased risk of melanoma developing within congenital nevi, especially very large ones, so if any change has been noted it should be checked by a doctor.

Halo naevus

Sometimes the skin around a mole loses its color so the mole appears to be surrounded by a white ring. This halo naevus occurs most often in children and teenagers. It is harmless, and with time the central mole and the white ring disappear. Loss of color may also be seen in melanoma, so if in doubt, it should be checked by a dermatologist.

Freckles

Freckles are small pale brown flat marks, more common in fair skinned individuals, especially those with red hair and blue eyes. They occur in sun exposed areas of skin, and are darker and more numerous during the summer months.

Atypical naevi

Atypical naevi, also called Clark's nevi, are moles that have unusual features such as an indistinct edge and/or larger size, often resembling a cancerous mole (melanoma), but are actually benign. Because of their worrying appearance, they are often removed, although this is not always necessary. People with atypical naevi may have an increased risk of developing melanoma, especially if there has been a close family member who has had a melanoma.

Change in a mole

Malignant melanoma is a cancerous growth occurring in melanocytes (pigment cells). A melanoma may look quite like a harmless mole.

If a mole changes size, shape or color, or a new one develops in adult life it should be evaluated by a doctor or preferably by a dermatologist. The dermatologist may examine the mole by dermoscopy. It is not always possible to tell whether the lesion is a melanoma, so sometimes it is necessary to cut the mole out for pathological examination.

Removal of moles

Although most moles are harmless and can be safely left alone, moles may be treated under the following conditions:

• Possible malignancy: a mole that has bled, has an unusual shape, is growing rapidly or changing color.
• Nuisance moles: a mole that is irritated by clothing, comb or razor.
• Cosmetic reasons: the mole is unsightly.

Shave biopsy

Treating a protruding mole is simple using a procedure called a shave biopsy. After numbing the skin with local anaesthetic the doctor removes the projecting part of the mole with a scalpel or by electrosurgery (e.g. Surgitron method). The wound heals to leave a flat white mark, but sometimes the colour remains the same as the original mole.

Excision biopsy

Excision biopsy is necessary if the mole is a flat one or melanoma is suspected. The full thickness of the skin is removed and the wound is sutured (stitched). The specimen should always be sent to the laboratory for pathological examination (histology). The resulting scar may be just a thin line, but is sometimes more noticeable than the mole was.

The coarse hair that sometimes grows in a mole can be removed by shaving. Plucking may cause inflammation resulting in a painful lump under the mole. The hair can only be removed permanently by electrolysis or excision of the whole mole.

Skin Examinations

Perform a self skin examination monthly: report significant changes in moles or new lesions to your doctor or dermatologist.

Arrange to have a skin examination regularly if you have numerous moles, atypical moles, previous skin cancer or your doctor recommends this.

Photographic records can be useful if there are numerous moles &/or atypical naevi. Sophisticated digital mole mapping systems including dermoscopic images are of particular value in the diagnosis of melanomam as subtle changes can be detected on repeat scanning.

Skin tags

Skin tags are very common soft harmless lesions that appear to hang off the skin. They are also described as:

• Acrochordons
• Papillomas
• Fibroepithelial polyps
• Soft fibromas
• Pedunculated (this means they are on a stalk)
• Filiform (this means they are thread-like)

Skin tags develop in both men and women as they grow older. They are skin coloured or darker and range in size from 1mm to 5cm. They are most often found in the skin folds (neck, armpits, groin). They tend to be more numerous in obese persons and in those with type 2 diabetes mellitus.

Skin tags are made up of loosely arranged collagen fibres and blood vessels surrounded by a thickend or thinned-out epidermis.  Seborrhoeic keratoses, viral warts or molluscum contagiosum  may resemble skin tags.

What causes skin tags?

It is not know what causes skin tags. However, the following factors may play a role:

• Chaffing and irritation from skin rubbing together
• High levels of growth factors, particularly during pregnancy or in acrogmegaly (gigantism)
• Insulin resistance (syndrome X)
• Human papilloma virus (wart virus)

How can they be removed?

Skin tags can be removed for cosmetic reasons by the following methods:

• Cryotherapy (freezing)
• Surgical excision (often with scissors)
• Electrosurgery (diathermy)
• Ligation (a suture is tied around the neck of the skin tag)

Dermal Fillers

As skin ages, there is loss of dermal collagen and subcutaneous fat. This results in characteristic contour changes in the facial profile and unwanted wrinkles.

With modern advances now, our surgeons are able to restore youth by removal of static wrinkles and lines, re-correction of profiles, adjust mild asymmetries in profile, improve skin defects and scars.  Dermal fillers can be broadly classifiable into either bio-degradeable or non-bio-degradeable.  Bio-degradeable fillers can last anywhere from 6 to 12 months, whilst the non-bio-degradeable fillers can last between 3 to 5 years.  Examples of dermal fillers that we use include: Restylane, Hydrafill and Sculptra. 

Facial implants

Facial augmentation is done for reconstructive or cosmetic purposes. It has become increasingly popular for the ‘normal’ everyday person to seek facial augmentation to remove or improve existing acne scars and facial lines or to enhance a specific facial area.

Over the years many filling (implant) agents have been developed. However, the search is still on for the ideal facial implant material. The ideal product should have the following properties:

• physiologically acceptable: incorporates itself with the body's tissues
• free of complications or side effects
• permanent: does not degrade with time
• easy to use: simple and quick procedure, e.g. injectable.

What are facial implants used for?

Facial implants can be used in reconstructions for areas that may have been scarred or altered by trauma. This may be done in conjunction with minor or major plastic surgery. The other increasing use of facial implants is in cosmetic surgery where patients seek these treatments to improve their appearance.

They are mainly used for the removal or improvement of scars caused by acne, correction of facial (wrinkle) lines, and enhancement or "filling in" of certain specific facial features such as the lips or chin.

Facial lines and features that can be corrected using implants

• Frown lines (glabellar lines)
• Smoke's lines (perioral lines)
• Marionette lines (oral commissures)
• Worry lines (forehead lines)
• Crow's feet (periorbital lines)
• Deep smile lines (nasolabial furrows)
• Smile lines (nasolabial lines)
• Cheek depressions
• Lip enhancement
• Witch's chin (chin augmentation)
• Acne scars
• Facial scars

We are located at: Patients Medical PC, 800 Second Avenue, Suite 900 (Between 42nd & 43rd Street), Manhattan, NYC, New York, NY 10017.